Malria is often referred to as the epidemic of the poor. Whilst the disease is in large part determined mainly by climate and ecology, and not poverty, the impact of malrua takes its toll on the poorest, those least able to afford preventative measures and medical treatment.

Suboptimal and poor hygiene and sanitation are the root causes

yes, your observation is absolutely right. Among many causes I think poor countries deserve to be affected by malaria because of illiteracy, health negligence, and religious fanaticism.

You are absolutely on the right track and this needs more research.

I live in tropics and just observing the number of houseflies, mosquitoes and rats in poor and rich households and suburbs separated only by a few hundred meters gives a good idea where to concentrate.

We have looked for affordable solutions like trapping the mosquitoes at entry points like windows by a special one way only screen and an inner normal mosquito screen, forming a "double screen trap".

It would be much more affordable and ecologically better solution than e.g. air conditioners which keep mosquitoes outside but do not reduce their populations.

Wish to hear if You have research or execution plans on this very important and very difficult front of working against poverty and misery.

My motto is: if it is not possible to eradicate malaria without eliminating poverty, then we need to eliminate them both.

Thank you for all your meaningful contributions. Let's continue the fight until both the poor and rich become free of malaria endemics.

The discussion is still ongoing please.

Or until there are no more poor and rich :-)

following

Dear Samuel,

Let's me remember your question and comment

Question: Malaria and poverty: Is there any relationship between the two?

Comment: It is observed that malaria incidence is more common in poor regions of the world. Any relationships in mechanisms of the two?

Following your question, comment and helpul answers from Mikko and others, I would like to give my humble contribution. You can see it as a preprint to downoload for free at bioRxiv:

Parasitology, Poverty and Prevention: is there any relationship between the three P? Is it possible to eradicate Parasitic diseases without eliminating Poverty?Guyguy Kabundi Tshima, Paul Madishala Mulumba doi: https://doi.org/10.1101/544007This article is a preprint and has not been peer-reviewed.

How is it sound?

Also for free, I provided 5 others preprints in the references for a best understanding of the concept of Poverty.

1. Tshima KG. 2019. What is the explanation for Plasmodium vivax malarial recurrence? Experience of Parasitology Unit of Kinshasa University Hospital of 1982-1983 and 2000-2009 bioRxiv doi: 10.1101/537027

2. Tshima KG, Mulumba MP. 2019. More accuracy estimation of the worm burden in the ascariasis of children in Kinshasa bioRxiv doi: 10.1101/537126

3. Tshima KG, Mulumba MP. 2019. The reconstitution of body mass index in HIV positive subjects under antiretroviral treatment in Kinshasa bioRxiv doi: 10.1101/524462

4. Tshima KG, Mulumba MP. 2019. Inquiry in Ridding the Democratic Republic of the Congo of sleeping sickness, a dream at our fingertips: comparing to the Epidemiology of human African trypanosomiasis in the Democratic Republic of the Congo 2002-2003 bioRxiv doi: 10.1101/522771 (under peer review)

5. Tshima KG, Mulumba MP. 2019. Contamination in the context of an Ebola outbreak: in-depth exploration of variables of hospital activities on infection control practices (manuscript waiting the launch of MedRxiv)

Thank you Tshima for the useful ref materials.

Thanks for accepting my answer.

There are several factors to why malaria is common with impoverished people...

1) Lack of awareness

2) social disadvantages

3) socioeconimic inequity

4) Lack of effective governance

5) lifestyle practice— waste management and sanitation practice.

Lack of awareness could be a factor due to poor education and mindfulness.

Social disadvantages could possibly be a factor where people cannot have access to quality healthcare and other community life support.

Socioeconomic inequity is a situation where there is injustice to the economic life of people within a particular society. Areas that are undeveloped are places where there are low businesses with low salaries. And it is so difficult for people within these communities to live healthy.

Lack of effective governance is where the government isn’t doing enough to ensure the health and wellbeing of the people are well protected and promoted. Else, communities will not be empowered enough to be more independent and to be mindful (through Asset-based Community Development) against the prevalence of malaria among impoverished communities.

Working to overcome poverty demands abandoning completely political sectarianism, abandoning traditional western political left and political right fighting with each others.

When every one is doing her or his best, one can of course call oneself with any political label, if wishes. Me I call myself centre-left but realizing that others with identical goals and methods working to overcome poverty wish to call themselves conservatives and that is fine for me.

Showing one's ethnic, civilizational, political, religious, linguistic, age, sex etc colors helps communication and helps thinking and finding solutions together.

As long as we maintain the common goal, finishing with warms and arms and poverty for ever.

Why can’t I edit my answer and do some corrections to the typograhical errors...

“Else, communities will not be empowered to be more independent through Asset-based Community Development”.

Dears William and Mikko,

Thanks for your answers, you have described the situation of the Democratic Republic of the Congo known as a rich country but in fact data on field show exactly what you described and what should be done to solve the problem of poverty and consequently malaria.

It then implies that both citizens and leaders, especially of the sub-Saharan Africa most wake up to fight this common enemy call poverty which predisposes majority to many ailments including malaria. Although, ecological factors have been reported to play significant role in the distribution and intensity of the disease in the region because of the suitability of the climatic conditions for the survival and reproduction of the vector (mosquitoes).

I got impression that the last presidential elections, despite its inevitable shortcomings, moved DRC little bit in this direction. That is uniting people of opposing political sects at different levels.

And this would give more chances that scientists of sociology, economy, public health, agriculture etc etc would be heard, at all levels, from top to the population.

My last time working in DRC dates back to 2006.

And for interest, my idea of developing the "Double Screen Mosquito Screen" to trap them at windows and other entry points and hence not let them return to shadow and shelter when not able to pass a simple mosquito window screen,

I started to develop it while in Kindu, DRC in 2004.

But it took until 2017 to have the research planned team built up, research done and published ( 3D mosquito screens, Ayman Khattab et al).

This could have been in two years if there had been research funds available more readily.

And the same problem continues with efforts to modify it to the Sandflies as well.

The link between malaria and climate in Kinshasa, Democratic Republic of the Congo in the bioRxiv preprint:

What is the explanation for Plasmodium vivax malarial recurrence? Experience of Parasitology Unit of Kinshasa University Hospital of 1982-1983 and 2000-2009.

From the preprint, I highlighted the link between malaria and climate:

OBJECTIVE

I wanted to highlight the link between the rainiest month and positive microscopy for malaria control purposes

RESULTS

November 2001 had the high number of positive samples.

CONCLUSION

Efforts for malaria control should be focus on the rain months.

DISCUSSION

The number of positive cases was recorded in 2001. 2001 was marked by the beginning of the resistance on antimalarials drugs involving a change towards the artemisinin derivatives, but it was in 2005 that the national malaria control programme PNLP introduced the combination of artesunate-amodiaquine to treat cases of uncomplicated malaria or simple malaria forms, also Artemether-Lumefantrine and Dihydroartemisinin-piperaquine for complicate malaria forms. The old combination was sulfadoxine and pyrimethamine for uncomplicate malaria and quinine for complicate malaria forms .

It was also observed in the last quarter of the year with a pic or the highest number of confirmed samples at the month of November (Figure 5).

In Kinshasa, the last three months of the year is the period of heavy rain with temperatures between 30 ° C and 38 ° C. These conditions are favorable to the proliferation of Anopheles that would promote the transmission of malaria during this time of the year without the use of mosquito preventive measures.

RECOMMENDATION

We promoted the use of the insecticide impregnated nets.

MY RECOMMENDED SOLUTION.

Malaria parasite does thrive in areas that are habitable for it. Therefore, it’s not suitable enough to try and manage the prevailing effects of malaria parasite (such like buying and distributing mosquito nets and insecticides), but instead, a diagnostic approach should be taken to drastically reduce (more like eradicating) the prevailing effects of malaria parasite.

With my factors; why Malaria is common among impoverished communities, I will recommend that the ‘Top-down & Bottom-up’ model of approach should be adopted. Whereby situations that have not really helped in the eradication of malaria parasite can be effectively approached.

Now,

taking a critical look at those factors one after the other. The ‘Top-Down’ approach helps your diagnosis to say if some of those factors are due to government negligence and therefore, appropriate steps can be taken by the government to ensure those factors do not exist anymore for malaria parasite to thrive.

The ‘Bottom-Up‘ approach helps your diagnosis to say if some of those factors are due to community/Individual negligence and therefore, appropriate steps can be taken by the individuals (within the community) to ensure those factors are no longer in existence.

And I think this solution in over all, will also help to close the social, health and economic gap impacting on community health.

Dear William,

Many thanks for your recommended solution. Based on it, I would like to share with you the POSTER 421 on page 224 in the ABSTRACT BOOK MEDICINE AND HEALTH IN THE TROPICS Marseille-France 11-15 September 2005. I have been involved in the study. So, I travelled in the selected DRC cities : Kinshasa, Kimpese, Kisangani, Lubumbashi,... for the study supported by USAID via the school of public health of the University of Kinshasa.

Our reply:

A coverage of 60% ITN in a village may be suitable enough to try and manage the prevailing effects of malaria parasite because it may offer a general protection ( insecticides in mosquito nets may kill mosquito in houses and reduce their number in the community level), but the coverage was very low in the DRC meaning that we were so far to reach the coverage of 60% ITN in each surveyed village. A vaste coverage should drastically reduce the prevailing effects of malaria parasite.

Reference: https://festmih.eu/wp-content/uploads/2017/08/4th-ECTMIH-Marseille-2005-Abstract-book.pdf.

IMPORTANT NOTICE: The abstracts included in this book are the proceedings of the Medicine and Health in the Tropics‚ Congress, as provided by the authors, without modification or copy-editing. The organizers of the Congress are, therefore, in no way responsible for abstract presentation or scientific content.

P421

MONITORING NET COVERAGE FOR MALARIA CONTROL IN THE DEMOCRATIC REPUBLIC OF THE CONGO

BOBANGA L.T.2, WOLKOM A.3, HAWLEY W.3, BEACH R.3, DOTSON E.3, TSHEFU K.A.4, MULUMBA M.P.2, KABUYA W.1, MWAMBA R.1, GIKAPA J.6, TSHIMA K.2

1. Basics DRC, KINSHASA, DEMOCRATIC REPUBLIC OF THE CONGO

2. Service of parasitology, Kinshasa School of Medecine, KINSHASA, DEMOCRATIC REPUBLIC OF THE CONGO

3. Division of Parasitic Diseases, Centers of diseases control and prevention, ATLANTA GA, UNITED STATES

4. Kinshasa school of public health, KINSHASA, REPUBLIC DEMOCRATIC OF THE CONGO

5. School of medecine, KINSHASA, DEMOCRATIC REPUBLIC OF THE CONGO

6. Santé Rurale(SANRU), KINSHASA, DEMOCRATIC REPUBLIC OF THE CONGO

Background.

In DRC, malaria is endemic and a significant source of morbidity and mortality. In 2001, DRC endorsed Abuja Declaration and the National Malaria Control Program (PNLP) initiated to protect children and pregnant women and to reduce poverty in DRC . Objectives are 60% Household with at least one ITN, 60% children sleeping under ITN and 60% Pregnant Women sleeping under ITN. With some partners the ministry of Health are implementing ITN in some health zones for more than 1 year. Differents distribution approaches used by partners. Than evaluation of these appears necessary.

Objectives.

To evaluate coverage and equity of distribution.To identify factors influencing use of net, and strengths and weakness of different programmatic approaches.

Methodology.

Surveys Conduct community-based surveys in 9 Health Zones (Kinshasa, Mbuji Mayi, Tshikaji, Pawa, Kisangani, Kimpese, Lodja, Vanga and Lubumbashi) Interviews and documentary review Health zones responsible interviewed.

Results.

ITN household possession: 14-49%. Proportion of pregnant women using ITN: 5-49%. Proportion of children sleeping under ITN: 5- 36%. Malaria prevention is the principal factor influencing ITN use preceding nuisance. Cost is the principal barrier to ITN acquisition.

Conclusion.

Different partners use different approaches. Distribution is not equitable in different groups. Coverage in progress in DRC but new consensus is needed between PNLP and partners.

Please take a look at the following useful references.

Article Why is malaria associated with poverty? Findings from a coho...

Article Poverty and malaria morbidity in the Jirapa District of Ghan...

Article Is malaria a disease of poverty? A review of the literature

Article Malaria and Poverty

Thank you Singh for the ref.

Yes, there is a relationship between Malaria and poverty.

Good and helpful links by Dr. Arvind Singh. Many thanks.

Malaria disease is common in the developing economies especially the Sub-Saharan Africa with high rate of poverty.

It was found that some poor countries around the world have many epidemic diseases especially Malaria.

Poverty maybe associated with less logistics and infrastructure to prevent malaria.

As far as my perception goes, definetly there is a relationship between malaria and poverty. In one way because of poverty, you might not eat nutritious food which might result in low immunity power. In another way you might not have enough money to purchase mosquito repellents to prevent mosquitoes in your surroundings where you live.

I sincerely appreciate all your positive contributions.

May be most of poor people resided in areas where malarial parasite or vector is congenial for their growth and distribution.

The relationship between poverty and malaria has long been recognized but its paths are multiple and complex. Malaria is often referred to as the epidemic of the poor. Whilst the disease is in large part determined mainly by climate and ecology, and not poverty, the impact of malaria takes its toll on the poorest, those least able to afford preventative measures and medical treatment.